European Association of Urology Nurses – EAUN

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EAUN-EUSC Workshop on ERAS protocols after cystectomy

This year the 6th Emirates International Urological Conference (EUSC) in Abu Dhabi in November 2017 was held in in conjunction with the World Congress on Videourology & Advances in Clinical Urology. It was the third time that the EAUN had the pleasure to participate in the conference with a nurses’ workshop.

The conference was attended by about 800 participants with the nurses’ workshop attracting 50 nurses.

Radical cystectomy is a complex procedure involving lymphadenectomy, cystectomy and harvesting bowel tissues to use in a urinary diversion. More than 60% of the patients undergoing radical cystectomy experience at least one complication within the first three months post-operatively and following Enhanced Recovery After Surgery (ERAS) protocols might improve postoperative outcomes. In 1997 the first paper from Henrik Kehlet described the impact of the surgical stress response to organ dysfunction and how the stress response could be minimised. The surgical stress response is induced by surgery and is a complex response with an increase in catabolic hormones and a reduction in anabolic hormones, hyper-metabolism and altered carbohydrate and protein homeostasis. All these responses enhance the risk of complications.

Knowing that more than 60% of the patients undergoing radical cystectomy experience complications, the surgical stress response is a problem. ERAS protocols aim to minimize the physiologic and psychological stress effects during and after surgery.

During the last decade there is a growing awareness regarding the importance of nursing interventions in ERAS. Thus, the workshop aimed to present the rationale of ERAS protocols, as well as the key principles for involving the patient in lifestyle changes and self-care. Looking at nursing interventions, information and assessment of the patient are the most important factors, preoperatively. At preadmission the first risk assessment should be made already in the out-patient clinic and include nutrition, physical activity, smoking, alcohol and education on how lifestyle habits influence surgical outcome.

The lectures also presented the EAUN recommendations for urostomy and neobladder management as well as the principles of surgical wound care. Pre-operative stoma education has been shown to significantly reduce “delayed discharge” due to better patient self-care. One of the sessions in the workshop introduced the Urostomy Education Scale which is a validated and evidence-based tool to document patients’ level of stoma self-care skills.

As shown in this photo there was a great interest on how to assess the patient using the Urostomy Education Scale. The introduction to the materials used during the workshop such as catheters and urostomy bags was done by Coloplast and Wellspect HealthCare representatives.